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f zo JS e .emu,ICE Par ���© —ozy <br /> Intake &Approval Sheet PERMIT STAFF ONLY) # • <br /> BUILDING PLANNING <br /> intake OK by: Date: Intake OK by: t9if , Assign To: eSs Date: 2/Z2,2y <br /> intake Comments: Intake Commen s: <br /> Zone R.—I . <br /> ❑Make this a"W"Permit ❑SRC Required(Pre-insp) Overlay/Agreement <br /> Bldg/Ti/Addn/Rem Size Nonresidential Use a�eche°a{'io en# $. <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories Proposed No.of Dwelling Units: -- <br /> Basement El No Kyes,0/Unfin Total No.of Dwelling Units: <br /> Type of Construction V if Planning/Landscape Inspection Required before Final? [(Yes J'No <br /> Occupancy Group Pc a..' 6I mt S ( "In Lieu"Fee:Type: Amount$0 <br /> Occupancy Load 7(f School Impact Fee: Total $ <br /> Cert.of Occpuancy Required? t:INo [(Yes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 KI2018 02015 ['Everett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers:pUpdate Existing[(New System [(Not Req'd Park Impact Fees for permits applied for after 1/112022: <br /> -- Reason Sprinklers Required: Park Impact Fee Total$O' (net due after credit forexistiing uses) <br /> Fire Alarm: NI-Update Existing[(New System ❑Not Req'd Fee Schedule Used For Calculation(Year): ^mnn11111 - <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req`d for perrrilt? DYes ®No <br /> Add'I RCW 64.55 does required prior to final? [(Yes l(\Io Additional Notes: <br /> VALUATION CALCULATION: Total$ S1 d O 0/6 0 6 <br /> Approved By:/.t� Date:Zf zz.f z <br /> PUBLIC WORKS <br /> Intake OK by: Date: _ <br /> -.....,„ <br /> • Intake Comments: IAW Review&Worksheet Needed if: <br /> • ,I OSys Dev Eval: <br /> Additional Notes: { DWater ❑Sewer ❑Storm <br /> DTraffic Mitigation EvaI <br /> F <br /> Approved By: C t 8 et Date: `��•")/p1,t( , 1 OSite Work/Drainage(shown/tr(ggered) <br /> . / ffAddress Letter <br /> FIR); DEPARTMEINt DSackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: i(dental,medical,animals,mortuary, <br /> p )hospital,supportive housing) <br /> OFire Sprinklers ❑Fire Alarm ❑Other: r <br /> Additional Notes: [(This Permit Is Approved by Public Works ' <br /> [(See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 A Separate PW Permit is Required(Permit#:PW ) - <br /> Review of As-Built Plans-NO FiRE FEE AND ❑is fully digital <br /> El Minimal or No Fire Scope-NO FIRE FEE 0 Is located in this folder <br /> El Review/Inspection Scope-ADD FIRE FEE E{ Is in a Separate Green Folder(join with this folderfor permit issuance) <br /> Approved By:(13iOGt/i(1 Date: 3,. 1`2— 3 Q Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ublic Works has no scope on this permit---PW Not Required <br /> ELECTRICAL/PLUMBING . dditional Notes: <br /> Additional Notes: <br /> Approved By: Date: Completed By:I� Date: 21 iS--l 4,2.-4- <br />